Skip to main content

Fungal Infections of the Lower Respiratory Tract

  • Chapter
  • First Online:
Airway diseases

Abstract

Fungal infections are often considered in cases who get late diagnosis of bacterial pneumonia or who are resistant to antimicrobial treatment against bacterial pneumonia. The risk of fungal infections in the lower respiratory tract has increased in patients under immunosuppressive treatments due to different group of diseases such as immunocompromised malignancies, HIV, hematological diseases, organ transplantation, or autoimmune diseases. Especially with increasing opportunities in intensive care units, it has entered among the hospital- and intensive care-emergent infections in the patient group with diabetes, kidney failure, and chronic obstructive pulmonary disease. Some fungal species colonize only in the airways, while others reveal true infections with a different course. It is very difficult to distinguish between these two situations. The fungi that cause the infection differ according to the selected population and geographical region. Endemic fungi are usually self-limiting in healthy individuals, but the disease is more common in men than women due to the protective effect of estrogen.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Özlü T, Metintaş M, Karadağ M et al. Akciğerin Fungal İnfeksiyonları. In Kaya A, editor. SolunumSistemiveHastalıklarıKitabı, İstanbul TıpKitabevi; 2010.

    Google Scholar 

  2. Kumbasar ÖÖ, Akçay Ş, Akova M et al. TürkToraksDerneğiBağışıklığıBaskılanmışErişkinlerdeGelişenPnömoniTanıveTedaviUzlaşıRaporu. TürkToraksDergisi. 2009; 10.

    Google Scholar 

  3. Pagano L, Busca A, Candoni A, et al. Risk stratification for invasive fungal infections in patients with hematological malignancies: SEIFEM recommendations. Blood Rev. 2017;31(2):17–29. https://doi.org/10.1016/j.blre.2016.09.002.

    Article  PubMed  Google Scholar 

  4. Chen K, Wang Q, Pleasants RA, et al. Empiric treatment against invasive fungal diseases in febrile neutropenic patients: a systematic review and network meta-analysis. BMC Infect Dis. 2017;17(1):159. https://doi.org/10.1186/s12879-017-2263-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Li Z, Gen L, Meng G. Pathogenic fungal infection in the lung. Front Immunol. 2019;10, 1524 https://doi.org/10.3389/fimmu.2019.01524.

  6. Latge JP. The pathobiology of aspergillus fumigatus. Trends Microbiol. 2001;9:382–9. https://doi.org/10.1016/S0966-842X(01)02104-7.

    Article  CAS  PubMed  Google Scholar 

  7. Kronstad JW, Attarian R, Cadieux B, et al. Expanding fungal pathogenesis: Cryptococcus breaks out of the opportunistic box. Nat Rev Microbiol. 2011;9:193–203. https://doi.org/10.1038/nrmicro2522.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Smıth JA, Kauffman CA. Pulmonary fungal infections. Respirology. 2012;17:913–26. https://doi.org/10.1111/j.1440-1843.2012.02150.x.

    Article  PubMed  Google Scholar 

  9. Nseir S, Jozefowicz E, Cavestri B, et al. Impact of antifungal treatment on Candida-pseudomonas interaction: a preliminary retrospective case-control study. Intensive Care Med. 2007;33:137–42. https://doi.org/10.1007/s00134-006-0422-0.

    Article  PubMed  Google Scholar 

  10. Hamet M, Pavon A, Dalle F, et al. Candida spp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia. Intensive Care Med. 2012;38:1272–9. https://doi.org/10.1007/s00134-012-2584-2.

    Article  PubMed  Google Scholar 

  11. Khasawneh F, Mohamad T, Moughrabieh MK, et al. Isolation of aspergillus in critically ill patients: a potential marker of poor outcome. J Crit Care. 2006;21:322–7.

    Article  PubMed  Google Scholar 

  12. Garnacho-Montero J, Olaechea P, Alvarez-Lerma F, et al. Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient. Rev EspQuimioter. 2013;26(2):173–88.

    Google Scholar 

  13. Marchetti O, Lamoth F, Mikulska M, et al. ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients. ECIL Bone Marrow Transplant. 2012;47:846–54. https://doi.org/10.1038/bmt.2011.178.

    Article  CAS  PubMed  Google Scholar 

  14. Bassetti M, Righi E. Fungal pulmonary infections: the conservative approach. European Respiratory Monograph. 61:37–49. https://doi.org/10.1183/1025448x.10040412.

  15. Shi XY, Liu Y, Gu XM, et al. Diagnostic value of (1 → 3)-β-D-glucan in bronchoalveolar lavage fluid for invasive fungal disease: a meta-analysis. Respir Med. 2016;117:48–53. https://doi.org/10.1016/j.rmed.2016.05.017.

    Article  PubMed  Google Scholar 

  16. Zhang L, Guo Z, Xie S, et al. The performance of galactomannan in combination with 1,3-β-D-glucan or aspergillus-lateral flow device for the diagnosis of invasive aspergillosis: evidences from 13 studies. J Diagn Microbiol Infect Dis. 2019;93(1):44–53. https://doi.org/10.1016/j.diagmicrobio.2018.08.005.

    Article  CAS  Google Scholar 

  17. Cruciani M, Mengoli C, Barnes R, et al. Polymerase chain reaction blood tests for the diagnosis of invasive aspergillosis in immunocompromised people. Cochrane Database Syst Rev. 2019;9(9):CD009551. https://doi.org/10.1002/14651858.CD009551.pub4.

    Article  PubMed  Google Scholar 

  18. Küpeli E, Ulubay G, Akkurt ES, et al. Long-term pulmonary infections in heart transplant recipients. Exp Clin Transplant. 2015;13(1):356–60. https://doi.org/10.6002/ect.mesot2014.p205.

    Article  PubMed  Google Scholar 

  19. Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(3):327–60. https://doi.org/10.1086/525258.

    Article  CAS  PubMed  Google Scholar 

  20. Jewkes J, Kay PH, Paneth M, et al. Pulmonary aspergilloma: analysis of prognosis in relation to haemoptysis and survey of treatment. Thorax. 1983;38:572–8. https://doi.org/10.1136/thx.38.8.572.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Serasli E, Kalpakidis V, Iatrou K, et al. (2008) Percutaneous bronchial artery embolization in the management of massive hemoptysis in chronic lung diseases. Immediate and long-term outcomes. Int Angiol. 2008;27(4):319–28.

    CAS  PubMed  Google Scholar 

  22. Farid S, Mohamed S, Devbhandari M, et al. Results of surgery for chronic pulmonary aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence—a National Centre’s experience. J Cardiothorac Surg. 2013;8:180. https://doi.org/10.1186/1749-8090-8-180.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and Management of Aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63(4):e1e60. https://doi.org/10.1093/cid/ciw326.

    Article  Google Scholar 

  24. Cesar JMS, Resende JS, Amaral NF, et al. Cavernostomy x resection for pulmonary aspergilloma: a 32-year history. J Cardiothorac Surg. 2011;6:129.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lang M, Lang AL, Chauhan N, et al. Non-surgical treatment options for pulmonary aspergilloma. Respir Med. 2020;164:105903. https://doi.org/10.1016/j.rmed.2020.105903.

    Article  PubMed  Google Scholar 

  26. Shah A, Panjabi C. Allergic bronchopulmonary aspergillosis: a perplexing clinical entity. Allergy Asthma Immunol Res. 2016;8(4):282–97. https://doi.org/10.4168/aair.2016.8.4.282.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Agarwal R, Khan A, Garg M, et al. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis. World J Radiol. 2012;4(4):141–50. https://doi.org/10.4329/wjr.v4.i4.141.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013;43:850–73. https://doi.org/10.1111/cea.12141.

    Article  CAS  PubMed  Google Scholar 

  29. Patterson R, Greenberger PA, Radin RC et al. (1982) Allergic bronchopulmonary aspergillosis: staging as an aid to management. Ann Intern Med;96:286–291. 95. https://doi.org/10.7326/0003-4819-96-3-286.

  30. Greenberger PA, Patterson R. Diagnosis and management of allergic bronchopulmonary aspergillosis. Ann Allergy. 1986;56:444–8.

    CAS  PubMed  Google Scholar 

  31. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006;42:1417–27. https://doi.org/10.1086/503427.

    Article  CAS  PubMed  Google Scholar 

  32. Husain S, Kwak EJ, Obman A, et al. Prospective assessment of Platelia aspergillus galactomannan antigen for the diagnosis of invasive aspergillosis in lung transplant recipients. Am J Transplant. 2004;4:796–802. https://doi.org/10.1111/j.1600-6143.2004.00415.x.

    Article  PubMed  Google Scholar 

  33. Maertens J, Maertens V, Theunissen K, et al. Bronchoalveolar lavage fluid galactomannan for the diagnosis of invasive pulmonary aspergillosis in patients with hematologic diseases. Clin Infect Dis. 2009;49:1688–93. https://doi.org/10.1086/647935.

    Article  PubMed  Google Scholar 

  34. Husain S, Clancy CJ, Nguyen MH, et al. Performance characteristics of the platelia aspergillus enzyme immunoassay for detection of aspergillus galactomannan antigen in bronchoalveolar lavage fluid. Clin Vaccine Immunol. 2008;15:1760–3. https://doi.org/10.1128/CVI.00226-08.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Clancy CJ, Jaber RA, Leather HL, et al. Bronchoalveolar lavage galactomannan in diagnosis of invasive pulmonary aspergillosis among solid-organ transplant recipients. J Clin Microbiol. 2007;45:1759–65. https://doi.org/10.1128/JCM.00077-07.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Patel ST, Eschenauer GA, Stuckey LJ, et al. Antifungal prophylaxis in lung transplant recipients. Transplantation. 2016;100(9):1815–26. https://doi.org/10.1097/TP.0000000000001050.

    Article  CAS  PubMed  Google Scholar 

  37. Küpeli E, Ulubay G, Akkurt S, et al. Invasive pulmonary aspergillosis in heart transplant recipients. Exp Clin Transplant. 2015;13(1):352–5. https://doi.org/10.6002/ect.mesot2014.p204.

    Article  PubMed  Google Scholar 

  38. Limper AH, Knox KS, Sarosi GA, et al. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011;183:96–128. https://doi.org/10.1164/rccm.2008-740ST.

    Article  CAS  PubMed  Google Scholar 

  39. Barac A, Vukicevic TA, Ilic AD, et al. Complications of chronic necrotizing pulmonary aspergillosis: review of published case reports. Rev Inst Med Trop São Paulo. 2017;59:e19. https://doi.org/10.1590/S1678-9946201759019.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2016;47(1):45–68. https://doi.org/10.1183/13993003.00583.

    Article  CAS  PubMed  Google Scholar 

  41. Jeong W, Keighley C, Wolfe R, et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2019;25(1):26–34. https://doi.org/10.1016/j.cmi.2018.07.011.

    Article  CAS  PubMed  Google Scholar 

  42. Kontoyiannis DP, Marr KA, Park BJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001–2006: overview of the transplant-associated infection surveillance network (TRANSNET) database. Clin Infect Dis. 2010;50:1091–100. https://doi.org/10.1086/651263.

    Article  PubMed  Google Scholar 

  43. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634–53. https://doi.org/10.1086/432579.

    Article  PubMed  Google Scholar 

  44. Trifilio S, Singhal S, Williams S, et al. Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole. Bone Marrow Transplant. 2007;40:451–6. https://doi.org/10.1038/sj.bmt.1705754.

    Article  CAS  PubMed  Google Scholar 

  45. Vaughan C, Bartolo A, Vallabh N, et al. A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis-has anything changed in the past 20 years? Clin Otolaryngol. 2018;43(6):1454–64. https://doi.org/10.1111/coa.13175.

    Article  PubMed  Google Scholar 

  46. Tissot F, Agrawal S, Pagano L, et al. ECIL-6 guidelines for the treatment of invasive candidiasis, aspergillosis and mucormycosis in leukemia and hematopoietic stem cell transplant patients. Haematologica. 2017;102(433–444):62. https://doi.org/10.3324/haematol.2016.152900.

    Article  Google Scholar 

  47. Cornely OA, Arikan-Akdagli S, Dannaoui E, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis. Clin Microbiol Infect. 2014;20:5–26. https://doi.org/10.1111/1469-0691.12371.

    Article  CAS  PubMed  Google Scholar 

  48. Liu W, Feng RZ, Jiang HL. Scedosporium spp lung infection in immunocompetent patients: a systematic review and MOOSE-compliant meta-analysis. Medicine (Baltimore). 2019;98(41):e17535. https://doi.org/10.1097/MD.0000000000017535.

    Article  PubMed  Google Scholar 

  49. Singh N, Dromer F, Perfect JR, et al. Cryptococcosis in solid organ transplant recipients: current state of the science. Clin Infect Dis. 2011;47:1321–7. https://doi.org/10.1086/592690.

    Article  Google Scholar 

  50. Oliveira Fde M, Severo CB, Guazzelli LS, et al. Cryptococcus gattii fungemia: report of a case with lung and brain lesions mimicking radiological features of malignancy. Rev Inst Med Trop Sao Paulo. 2007;49(4):263–5. https://doi.org/10.1590/s0036-46652007000400014.

    Article  PubMed  Google Scholar 

  51. Skolnik K, Huston S, Mody CH. Cryptococcal lung infections. Clin Chest Med. 2017;38(3):451–64. https://doi.org/10.1016/j.ccm.2017.04.007.

    Article  PubMed  Google Scholar 

  52. Ji S, Ni L, Zhang J, et al. Value of three capsular antigen detection methods in diagnosis and efficacy assessment in patients with cryptococcal meningoencephalitis. Zhonghua Yi Xue Za Zhi. 2015;95(46):3733–6. https://doi.org/10.3760/cma.j.issn.0376-2491.2015.46.003.

    Article  PubMed  Google Scholar 

  53. Vidal JE, Boulware DR. Lateral flow assay for cryptococcal antigen: an important advance to improve the continuum of HIV care and reduce cryptococcal meningitis-related mortality. Rev Inst Med Trop Sao Paulo. 2015;57(Suppl 19):38–45. https://doi.org/10.1590/S0036-46652015000700008.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Tenforde MW, Shapiro AE, Rouse B, et al. Treatment for HIV-associated cryptococcal meningitis. Cochrane Database Syst Rev. 2018;7(7):CD005647. https://doi.org/10.1002/14651858.CD005647.pub3.

    Article  PubMed  Google Scholar 

  55. Tagliaferri E, Menichetti F. Treatment of invasive candidiasis: between guidelines and daily clinical practice. Expert Rev Anti-Infect Ther. 2015;13(6):685–9. https://doi.org/10.1586/14787210.2015.1029916.

    Article  CAS  PubMed  Google Scholar 

  56. Wood GC, Mueller EW, Croce MA, et al. Candida sp. isolated from bronchoalveolar lavage: clinical significance in critically ill trauma patients. Intensive Care Med. 2006;32(4):599–603. https://doi.org/10.1007/s00134-005-0065-6.

    Article  PubMed  Google Scholar 

  57. Timsit JF, Schwebel C, Styfalova L, et al. Impact of bronchial colonization with Candida spp. on the risk of bacterial ventilator-associated pneumonia in the. ICU: the FUNGIBACT prospective cohort study Intensive Care Med. 2019;45(6):834–43. https://doi.org/10.1007/s00134-019-05622-0.

    Article  PubMed  Google Scholar 

  58. Hammarström H, Grankvist A, Broman I, et al. Serum-based diagnosis of pneumocystis pneumonia by detection of pneumocystis jirovecii DNA and 1,3-β-D-glucan in HIV-infected patients: a retrospective case control study. BMC Infect Dis. 2019;19(1):658. https://doi.org/10.1186/s12879-019-4289-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Esteves F, Lee CH, de Sousa B, et al. (1-3)-beta-D-glucan in association with lactate dehydrogenase as biomarkers of pneumocystis pneumonia (PcP) in HIV-infected patients. Eur J Clin Microbiol Infect Dis. 2014;33(7):1173–80. https://doi.org/10.1007/s10096-014-2054-6.

    Article  CAS  PubMed  Google Scholar 

  60. Damiani C, Gal SL, Costa CD et al. (2013) Combined Quantification of Pulmonary Pneumocystis jirovecii DNA and Serum (1¡3)--D-Glucan for Differential Diagnosis of Pneumocystis Pneumonia and Pneumocystis Colonization. J Clin Microbiol;51(10):3380–3388, https://doi.org/10.1128/JCM.01554-13.

  61. Stern A, Green H, Paul M, et al. Prophylaxis for pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst Rev. 2014; https://doi.org/10.1002/14651858.CD005590.pub3.

  62. Sampaio EP, Hsu AP, Pechacek J, et al. Signal transducer and activator of transcription 1 (STAT1) gain-of-function mutations and disseminated coccidioidomycosis and histoplasmosis. J Allergy Clin Immunol. 2013;131:1624–34. https://doi.org/10.1016/j.jaci.2013.01.052.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Bercovitch RS, Catanzaro A, Schwartz BS, et al. Coccidioidomycosis during pregnancy: a review and recommendations for management. Clin Infect Dis. 2011;53:363–8. https://doi.org/10.1093/cid/cir410.

    Article  PubMed  Google Scholar 

  64. Galgiani JN, Ampel NM, Blair JE, et al. Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of Coccidioidomycosis. 2016;63(6):e112–46. https://doi.org/10.1093/cid/ciw360.

  65. Blair JE, Chang YH, Cheng MR, et al. Characteristics of patients with mild to moderate primary pulmonary coccidioidomycosis. Emerg Infect Dis. 2014;20:983–90. https://doi.org/10.3201/eid2006.131842.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Thompson GR III, Lunetta JM, Johnson SM, et al. Early treatment with fluconazole may abrogate the development of IgG antibodies in coccidioidomycosis. Clin Infect Dis. 2011;53:e20–4. https://doi.org/10.1093/cid/cir466.

    Article  CAS  PubMed  Google Scholar 

  67. Hage CA, Ribes JA, Wengenack NL, et al. A multicenter evaluation of tests for diagnosis of histoplasmosis. Clin Infect Dis. 2011;53:448–54. https://doi.org/10.1093/cid/cir435.

    Article  PubMed  Google Scholar 

  68. Rivière S, Denis B, Bougnoux ME, et al. Serum aspergillus galactomannan for the Management of Disseminated Histoplasmosis in AIDS. Am J Trop Med Hyg. 2012;87(2):303–5. https://doi.org/10.4269/ajtmh.2012.12-0119.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Richer SM, Smedema ML, Durkin MM, et al. Improved diagnosis of acute pulmonary histoplasmosis by combining antigen and antibody detection. Clin Infect Dis. 2016;62(7):896–902. https://doi.org/10.1093/cid/ciw007.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Doyle TP, Loyd JE, Robbins IM. Percutaneous pulmonary artery and vein stenting: a novel treatment for mediastinal fibrosis. Am J Respir Crit Care Med. 2001;164:657–60. https://doi.org/10.1164/ajrccm.164.4.2012132.

    Article  CAS  PubMed  Google Scholar 

  71. Zhao YJ, Khoo AL, Tan G, et al. Network meta-analysis and Pharmacoeconomic evaluation of fluconazole, Itraconazole, Posaconazole, and Voriconazole in invasive fungal infection prophylaxis. Antimicrob Agents Chemother. 2015;60(1):376–86. https://doi.org/10.1128/AAC.01985-15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nevra Güllü Arslan .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Arslan, N.G., Eyüboğlu, F.Ö., Duarte, R. (2023). Fungal Infections of the Lower Respiratory Tract. In: Cingi, C., Yorgancıoğlu, A., Bayar Muluk, N., Cruz, A.A. (eds) Airway diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-22483-6_41-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-22483-6_41-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-22482-9

  • Online ISBN: 978-3-031-22483-6

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics